Gastroesophageal Reflux Disease (GERD)

GERD is a collection of symptoms and pathologic changes in the upper aerodigestive tract that are related to gastroesophageal reflux (the backwash of stomach contents which are often very acidic into the esophagus). The most common symptom associated with this condition is heartburn which is very common in our population and which usually does not require any treatment. Acid reflux into the esophagus can cause esophagitis which is inflammation of the mucosa lining the esophagus. GERD can cause symptoms outside of the esophagus such as laryngitis, asthma, and aspiration pneumonia when the reflux extends all of the way up the esophagus and into the mouth. If this occurs at night when the person is sleeping, then choking and aspiration into the lungs can occur.

Whereas up to 40% of the population experiences heartburn at some time, only about 60% of those persons have significant GERD. The incidence of symptoms increases with age and are more common during pregnancy probably because of the hormonal effects on the lower esophageal sphincter and by the increased intraabdominal pressure. Many people find that their symptoms increase with small increases in their weight and with the tightening that they feel at their waist line. Often losing 8-10 lbs. is all that it takes to bring this condition under control. About 12% of people that have chronic GERD will develop Barrett's esophagus. This is a change in the cells lining the esophagus and as it progresses, it can be associated with cancerous changes developing.

What Causes GERD?

Several factors conspire to produce the symptoms of GERD. 1).The lower esophageal sphincter (valve) mechanism may not function properly and allows free reflux of stomach contents back up into the esophagus. 2).The esophagus and its peristalsis(what moves food from the mouth to the stomach) may be defect so that once reflux occurs, it cannot be cleared from the esophagus. 3).The stomach doesn't empty properly and stomach contents backs up and puts more pressure on the lower esophageal sphincter. The most common cause of GERD is 1 --an incompetent lower esophageal sphincter. Surgical procedures to treat reflux are aimed at recreating a competent lower esophageal sphincter.

Hiatal Hernia and GERD

Many patients are told that they have a "high hernia" that causes their heartburn and symptoms of GERD. This is only partially true. Many patients that have hiatal hernias do not experience reflux symptoms. Many patients that have severe reflux symptoms do not have hiatal hernias. Large hiatal hernias probably due contribute to the severity of some patients symptoms and repair of the hernia may alone improve their symptoms

Lifestyle Changes to Improve/Treat GERD

1. Lose weight-it is surprising how the loss of a few pounds can markedly improve symptoms.

2. Elevate the head of your bed on 6" blocks.

3. Take your H2 blocker (Zantac, Pepcid, etc), your proton pump inhibitor (Prilosec) and/or your promotility agent (Propulsid, Reglan) as directed by you physician.

4. Avoid late evening meals (after 6 pm)

5. Avoid nicotine, caffeine, chocolate, alcohol, fatty foods, and peppermint.

6. Avoid tight fitting clothing (jeans, girdles, etc)

Surgery for GERD

After a workup that may include an upper G I barium swallow, an endoscopy, an esophageal manometry, and a 24 hour pH monitoring, the patient may be referred for a discussion of surgical therapy. This is a strategy to reconstruct the competency of the lower esophageal sphincter mechanism.